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Friday, April 4, 2014

5000 B.C.: An Egyptian hero thinks about air

Sometime around 5,000 years before the birth of Christ a man was sitting in an otherwise empty cave cutting open the body of an ox. As he set the knife upon the animal's chest he observed the chest was moving, and he cracked open the ribs and saw that the heart was still beating, although as he held it in his hands the beating stopped. The animal was dead.

After the rain stopped his brother's arrived, and helped him carry the animal back to the women and children at the shelter cave. The men rushed along because the wind was blustery, and the sky looked ominous. Our hero observed as he ran his own chest went in and out, and something cool and refreshing entered his nose and filled his chest. He felt a beating in his chest.

Upon entering the cave he and his brother unloaded the ox, and he sat on the floor trying to catch his breath. He paid attention to his breathing, enjoying the "air" that entered into him. "What is this?" he wondered, as he approached the animal once more, and finished cutting it open. He observed the blood this time. He surely saw it many times before, but now he was observing it. What was it really?

He held his baby daughter later that night as he sat around the fire, and felt her hair, her face, and her chest. He felt her chest bob in and out, in and out, in and out. He put his cheek near her mouth, and his hand upon her chest, and felt a warm, humid breeze each time her stomach moved in. He wondered what it was she was "exhaling" and "inhaling."

The next day he was in the wilderness along the Nile again, and he wondered what the blue sky was. He speculated it must be a gift of the gods, as his grandfather taught him. He did not doubt his grandfather, although he wondered if there was something more to it. Out of fear of being taunted by his fellow men, and mainly out of fear of offending the spirits, he tried to squash these thoughts. But he couldn't squash these thoughts. He wondered if he was blessed by having them, or cursed.

He told these thoughts to one person and one person only, and that was his son. He also told his son that if he ate to many figs he'd become nauseated and probably toss out his lunch. He told his son about the poppy herbs he found in the fields and how he used them one day when his mother lay dying in the back of the cave. He prepared them into a drink, and she drank of it, and she felt no pain and she died peacefully.

He told his son how he watched his mother "breathing" as she lie there in her sleep, and he saw that she stopped breathing and she was no more: she was dead. The father told his son that he wondered if breathing was essential to life, and if breathing in the air was necessary for life. He told his son he wondered if there was some form of vital substance in the air that was essential to life. When you no longer breathed you no longer inhaled this substance. The same must be true of the animals as for humans.

The son remembered the words his dad spake, and he also remembered the vow his dad forced him to make: "Never tell anyone you cannot trust with this knowledge." He thought of these words as several years later he was inside a cave, awaiting out a rainstorm, cutting open an ox. He split the cavity wide open and he observed a heart between two lungs, and he saw the liver and spleen and kidneys. He came up with names for these organs.

Yet he didn't stop there. He found that there is a series of vessels throughout the body of the ox, and when he cut one of these vessels open blood spurted out. He decided these vessels must contain the essence of life, and that perhaps this "blood" contained the air that was inhaled during breathing. He wondered if this was the gods communicating to him.

He was told to worship the Nile as the Great River, the heart of the gods. The Nile was the soul of Egyptian life, and through the channels (metu) his fellow men made through the land the gods were able to nourish the land so the crops would grow and the animals and humans could stay alive. The Egyptians learned to worship the Nile, and celebrate it as the essence of life.

Several years later the Egyptians formed several cities around the Nile River. The great-great-great--great grandson from the same family is the sage of the village: the medicine man. Yet he is more than a medicine man, as he has the ability to communicate with the gods, acting as a mediator between the gods and the people. He was a priest, the same line of priests that would eventually become the physicians. He was, in essence, the first physician, communicating directly with the god Thoth, who was the secretary of the gods.

Alone in a mud-brick house this first physician traced the vessels around the body, and he found that they went to all the parts of the body: to the arms, fingers, legs, toes, chest, head, and brain. He also found that these vessels all seemed to originate in the heart, and so he speculated that perhaps the air is the substance of life, or the words of the gods, and perhaps this air flowed through the body through channels(metu)carrying with it the words or nutrients of the gods to nourish the body, just as the black mud flowed from the Nile through the land through channels (metu) carrying with it the words and nutrients of the gods to nourish the land.

In this way, he speculated, the gods communicate with the land and the human body through the metu. So as one day one of these priests learns about a new method of writing down words, and so he copies these words onto paper made of papyrus, and he rolls it into a scroll. Now all priests will have this wisdom. And he makes anyone who is to be taught this wisdom to make a sacred oath to the god Ra that he will not share this wisdom with anyone. He does not know where the oath came from, but he knows it is wise to repeat it, and to consider it sacrosanct (too valuable to be interfered with).

The wisdom taught is that the god's words are the air, and the heart is the Nile, and the vessels of the body are the metu thought which the Nile speaks to the various parts of the body and land. The heart, therefore, is the essence of life. The heart is the soul. The heart is as the Nile: the center of everything. Your home is the Nile-heart of your life. Your child is the Nile-heart of your life. Bread is the gift of the gods, and it "strengthens your heart." If you have the gods with you then goodness will be with you, and you will be of "good heart." Your children are the heart and soul of your life. You share a heart with your spouse.

In this sense, he believed that as the Nile was the center of life in Egypt, the heart was the center of life in the human body. He believed that all senses communicated with the heart: the ears, the eyes, the tongue, the fingers, the toes, the nose, and so forth. Every part of the body, including all the organs, communicated witht the heart. It was the where all thought, emotions and intelligence was formed. Heart, to the Egyptians, was used in lieu of our words for mind. They'd say things like "keep your heart on the project at hand," instead of saying "keep your mind on the task at hand."

There were other organs of the body, and these were merely helpers. The substance in the head was the brain, and it controlled the flow of mucus to the nose. There is a metu between the brain and the nose, and therefore the gods spoke through this metu as well. There is also a metu that connects the vessels of the various organs of the body, including the ovaries and testicles.

Life and good health of the land and civilization is determined by the flow of black mud through the land, carried by the floods of the Nile and through the channels. If there is some sort of obstruction or problem with the flow, then there is a problem with life and health. When the water doesn't flow to Memphus, then the crops do not grow, the animals die, and people suffer and die as well. Severe drought results in severe problems with life. If drought is ongoing this means the gods are no longer speaking with the lands, and this results in death.

Likewise, Life and good health is determined by the flow of air, blood, sperm, tears, saliva, mucus, urine, nutrients, and feces through the metu of the body of animals and humans. If something happens whereby this flow is altered or obstructed, then this is when diseases happen. If the flow is obstructed in the ovaries, then diseases of the ovaries occur. If the flow is obstructed between the brain and the nose, then diseases of the respiratory tract occur, such as diseases like coughing, sneezing, wheezing, panting, or increased phlegm. If all the flow is obstructed so that a drought in the body occurs, then the gods are no longer speaking and death happens.

Yet while the metu carry the words of the gods, they can also carry bad words or poisons (wehedu). They can also carry poisons that entered the body by demons or angry gods. They can also carry poisons that entered the heart by inhaling poisons of the many evil spirits, or by the poisons that entered the body through food. Sometimes such poisons can enter the body by the evil people around you, perhaps someone you love wants you sick or dead. In either case, good substances and bad substances flow through the metu.

These poisons can cause various diseases and death, just as the good words of the gods can cause health and life. The good words can keep the flow flowing smoothly, and the bad words can cause obstruction and drought. These poisons can cause a person's breathing to become weak and labored. These poisons can cause a person to pant or gasp for air, or to cough, or to have increased phlegm. These poisons can take away life by making the heart stop beating.

Sometime around 3100 B.C. a king by the name of Menes, or maybe it was Narmer (or perhaps they were one and the same), became ruler of all of Upper and Lower Egypt, and by now there are many scribes and physicians among the priesthood, and these are the educated people among the land of Egypt. They are educated in or near the temples of the gods in Heliopolis and Memphus and various other cities. Historians now refer to Egypt at this time as one of the first civilizations, or one of the first GREAT civilizations.

He shared this knowledge with all aspiring priests. These priests were made to say an oath that his father made him say: ""Never tell anyone you cannot trust with this knowledge." The knowledge was taught through the years to all the priesthood, but only the priesthood, or anyone, for that matter, who is privileged to an education. This knowledge, herefore, as was all knowledge, esoteric: a privilege to only the few.

One of the priests, perhaps an ancestor of our hero, attributed this wisdom to the god Thoth, and he wrote a series of books that would later become known as the Hermetic Books. The first copies were written on clay tablets and placed at the temples. Once papyrus was invented these books were recopied and recopied over many years, and many physicians had their own copies and perhaps their own versions. Samples of these texts are still preserved to this day, perhaps in the tombs of one of our hero priests. Many are still at rest with their original owners.

A sample of one of these is referred to as the Ebers Papyrus, and it was discovered between the legs of a mummy. The man it is named after, Georg Ebers, thought it was a copy of the original Hermetic books, and he even believed the author was the priest-physician-architect Imhotep. Yet later experts realized the Ebers Papyrus was more like an encyclopedia, and contained copies of magical, yet mostly rational medical remedies for the various ailments of the day. It was a copy of a copy, more than likely, and the material within it was dated to be as old as the oldest empires of Egypt, perhaps as far back as 3000 or 4000 B.C.

Yet even though it wasn't an original copy, it contained recipes that were probably used by the owner it was buried with, and this owner was probably a physician. He either made the copy himself or had a scribe make it for him. Or, perhaps this book was made specifically by a scribe to be placed in the tomb of this physician for him to use in the afterlife. Although in the margins are the notes of the author, with words such as "I tried this. It works great." Some also speculate this copy was not used by a physician in practice, so much as a textbook for an instructor or student.

Along with the recipes, it also contained parts of another book called the Book on the Vessels of the Heart, and it reads as follows:

The Physician's Secret: Knowledge of the Heart's movement and Knowledge of the Heart. There are vessels (metu) from it to every limb. As to this, when any physician... or any exorcist applies the hands or his fingers to the head, to the back of the head, to the hands, to the place of the stomach, to the arms or to the feet, then he examines the heart, because all his limbs possess its vessels, that is: if (the heart) speaks out of the vessels (metu) of every limb.

The parts copied described the then known anatomy of the human body that consisted of a heart that communicated to the rest of the body through a series of vessels that acted as metu (arteries, veins, ducts, muscles, and nerves). The priest-physician was taught that by feeling the pulse he could hear the words of the gods from the heart.

By comparing this beat with his own, he was instructed, he could determine if the heart beat is slow or fast, and this would help him determine if something wrong was going on with the body. It was then his job to diagnose the problem: where is the flow obstructed? Why? What remedy would correct it, an incantation or herbal remedy or both? The answer could often be found in the book.

On the other hand, if the heart beat was normal compared to his own, then the words of the gods had spoken: this person is healthy, or he will get better. Perhaps an incantation or a simple herbal remedy was in order to correct the ailment, or to prevent it from occurring in the future. The answer could often be found in the book.

The author of the Ebers Papyrus, the man who lived around 1600 B.C., shared with us some of the known anatomy of the day. Thanks to a 1937 interpretation by B. Ebbell, we know the Egyptians were aware of 46 vessels in the human body, and we know their basic anatomical wisdom as this:

There are 4 vessels in his nostrils, 2 give mucus and 2 give bloodThere are 4 vessels in the interior of his temples which then give blood to the eyes; all diseases of the eyes arise through them, because there is an opening to the eyes.There are 4 vessels dispersing to the head which effuse in the back of the head...There are 4 vessels to his 2 ears together with the (ear) canal, 2 on his right side and 2 to his left side. The breath of life enters into the right ear, and the breath of death enters into the left ear...There are 6 vessels that lead to the arms, 3 to the right and 3 to the left; they lead to his fingers.There are 6 vessels that lead to the feet, 3 to the right and 3 to the left; they lead to his fingers.There are 2 vessels to his testicles; it is they which give semen.there are 2 vessels to the buttocks, 1 to (the right) buttock adn the other to (the left) buttock.There are 4 vessels to the liver; it is they which give to it humor and air, which afterwards cause all diseases to arise in it by overfilling with blood.There are 4 vessels to the lung and to the spleen; it is they which give humor and air to it likewise.There are 2 vessels to the bladder; it is they which give urine.there are 4 vessels that open to the anus (rectum?); it is they which cause humor and air to be produced for it. Now the anus opens to every vessel to the right side and to the left side in arms and legs when (it) is overfilled with excrements.

However, in another section of the Ebers Papyrus it's noted that there are 22 vessels of the human body. Some think this was because they were aware that there were different kinds of vessels, such as arteries that carried air and life to the various parts of the body, and veins that carried poisons to various parts of the body. However, this is mere speculation. Our hero had no knowledge of circulation, nor did he understand a difference between arteries, veins, ducts, tendons and nerves, and perhaps the Egyptians didn't either. They did however, as noted above, note the flow of water/blood from the Nile/heart.

There was another book copied in the Ebers Papyrus, or at least parts of it. It is from here where we get many of our recipes for remedies. The book is called The Collection on the Expelling of the Wehedu. Wehedu is the Egyptian word that refers to the material that makes pus, or, in other words, poisons. The book offers remedies to get the poisons out of the body and fix the damage. One remedy for asthma-like symptoms, according to Ebbell anyway, consisted of using a primitive inhaler device:

Thou shalt fetch 7 stones and heat them by the fire, thou shalt take one therof and place (a little) of these remedies on it and cover it with a new vessel whose bottom is perforated and place a stalk of a reed in this hole; thou shalt put thy mouth to this stalk, so that thou inhalest the smoke of it. Likewise wit all stones. Thereafter thou shalt eat something fat, of fat meat or oil."

This might have been the remedy for cough, wheezing, gasping, or increased phlegm. To the modern reader this may seem rational, considering the inhalation of herbs allowed for the medicine to be applied where the injury occurs: in the respiratory tract; in the lungs. Yet this remedy more than likely was used for other purposes, perhaps to blow herbal remedies over the royal anus, or the anus of any sick person.

The Egyptians were infatuated with the flow of this metu, and they were also infatuated with the mouth and nose where the air and food and poisons entered, they were also concerned with the anus where it all exited. One common remedy of the Egyptians was regular purging (vomiting) or enemas (bowel movement), because they believed most poisons entered the body from the foods that were eaten, and such remedies cleansed the system, allowing for continued and prolonged flow of the good words through the metu of the body.

It was a normal routine for Egyptians, regardless of class, to purge themselves for three consecutive days each month, according to Herodotus, the great Greek Historian (484-425 B.C.). Another Greek historian, Diodorus (90-30 B.C.), said they sometimes purged themselves "every day and sometimes at intervals of three or four days."

This was the knowledge that lasted for over 3,000 years while the Egyptians ruled, and this knowledge was protected by laws that forbade the dissection of the human body, even by physicians trying to understand why diseases happened. Neither priest nor priest-physician disobeyed these laws, because they knew they were the wishes of the gods, who were omniscient.

Ancient Greek philosophers such as Thales and Miletos, and later Hippocrates, entered the schools at Heliopolis and they were taught the wisdom of the Egyptian books. They shared this knowledge with their fellow Greek men and women, and such wisdom was advanced slightly and shared with the rest of the western world.

Yet the idea that disease was a concept caused by the absorption of poisons carried by the vessels of the body into the intestines is an idea that was believed even as recent as the beginning of the 18th century. The Egyptians believed almost from their early days that diseases were caused by some kind of imbalance in the body, perhaps due to some poison or Wehedu. The Greeks likewise believed this, although they referred to it as an imbalance of the four humors: blood, phlegm, black bile and yellow bile. It was taught at the Asclepion Temples in Greece, by Hippocrates, by Galen, and by various other physicians.

Some poison, they believed, caused an increase or decrease in any one of these, causing an imbalance, and thus disease. The remedy, therefore, was to do something to recreate the balance. The remedy may be something as simple as allowing nature to take its course, or something more invasive as having the patient eat an excessive amount of figs to toss up the poisons, or a purging, or enema. It could also involve the process of bleeding the patient, and all these remedies were utilized even up to modern times. In some places of the world, the primitive world, these remedies are still utilized.

Yet it all began with our hero, a man who will never be known to history. He is a man without a face, a man without a name, a man without a known burial site, a man with no attribution, not even a random marker. Yet while others thank the Egyptians, or the Greeks, or the Romans for medicine, we know now that the man we must thank is our hero, the first man to think about air.

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Wit and Wisdom

History maketh a young man to be old, without either wrinkles or grey hairs; privileging him with the experience of age, without either the infirmities or inconveniences thereof. Yea, it not only maketh things past, present; but enableth one to make a rational conjecture of things to come. For this world affordeth no new accidents, but in the same sense wherein we call it a new moon, which is the old one in another shape; and yet no other than that hath been formerly. Old actions return again, furbished over with some new and different circumstances. (Thomas Fuller in the Epistle Dedicatory to his The History of the Holy War, March 6th, 1639).

About Me

John Bottrell is a respiratory therapist. He's a featured asthma and COPD writer for asthma.net and copd.net. He's the creator and occasionally writer for Respiratory Therapy Cave, the #1 respiratory therapy blog. He's an avid historian and creator of Asthma History. His blog posts have been featured in various newspapers, such as the Chicago Tribune. He has previously been a featured asthma/COPD writer for Healthcentral.com and asthma writer for Answers.com.